疼痛症状与肩袖撕裂严重程度不相关：393 例症状性非创伤性全层肩袖撕裂患者的横断面研究。
Symptoms of pain do not correlate with rotator cuff tear severity: a cross-sectional study of 393 patients with a symptomatic atraumatic full-thickness rotator cuff tear.
机构信息
University of Wisconsin, Research Park Clinic Sports Medicine Clinic, 621 Science Drive, Madison, WI 53711.
Vanderbilt University Medical Center, 4200 MCE South Tower, 1215 21st Avenue South, Nashville, TN 37232. E-mail address for J.E. Kuhn:
出版信息
J Bone Joint Surg Am. 2014 May 21;96(10):793-800. doi: 10.2106/JBJS.L.01304.
BACKGROUND
For many orthopaedic disorders, symptoms correlate with disease severity. The objective of this study was to determine if pain level is related to the severity of rotator cuff disorders.
METHODS
A cohort of 393 subjects with an atraumatic symptomatic full-thickness rotator-cuff tear treated with physical therapy was studied. Baseline pretreatment data were used to examine the relationship between the severity of rotator cuff disease and pain. Disease severity was determined by evaluating tear size, retraction, superior humeral head migration, and rotator cuff muscle atrophy. Pain was measured on the 10-point visual analog scale (VAS) in the patient-reported American Shoulder and Elbow Surgeons (ASES) score. A linear multiple regression model was constructed with use of the continuous VAS score as the dependent variable and measures of rotator cuff tear severity and other nonanatomic patient factors as the independent variables. Forty-eight percent of the patients were female, and the median age was sixty-one years. The dominant shoulder was involved in 69% of the patients. The duration of symptoms was less than one month for 8% of the patients, one to three months for 22%, four to six months for 20%, seven to twelve months for 15%, and more than a year for 36%. The tear involved only the supraspinatus in 72% of the patients; the supraspinatus and infraspinatus, with or without the teres minor, in 21%; and only the subscapularis in 7%. Humeral head migration was noted in 16%. Tendon retraction was minimal in 48%, midhumeral in 34%, glenohumeral in 13%, and to the glenoid in 5%. The median baseline VAS pain score was 4.4.
RESULTS
Multivariable modeling, controlling for other baseline factors, identified increased comorbidities (p = 0.002), lower education level (p = 0.004), and race (p = 0.041) as the only significant factors associated with pain on presentation. No measure of rotator cuff tear severity correlated with pain (p > 0.25).
CONCLUSIONS
Anatomic features defining the severity of atraumatic rotator cuff tears are not associated with the pain level. Factors associated with pain are comorbidities, lower education level, and race.
LEVEL OF EVIDENCE
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
背景
对于许多骨科疾病，症状与疾病严重程度相关。本研究的目的是确定疼痛程度是否与肩袖疾病的严重程度相关。
方法
对 393 例因创伤性、症状性全层肩袖撕裂而接受物理治疗的患者进行了队列研究。使用基线预处理数据来检查肩袖疾病严重程度与疼痛之间的关系。疾病严重程度通过评估肩袖撕裂的大小、回缩、肱骨头向上迁移和肩袖肌肉萎缩来确定。疼痛使用患者报告的美国肩肘外科医生（ASES）评分中的 10 分视觉模拟量表（VAS）进行测量。使用连续 VAS 评分作为因变量，肩袖撕裂严重程度和其他非解剖学患者因素作为自变量，构建线性多元回归模型。48%的患者为女性，中位年龄为 61 岁。优势肩占 69%。8%的患者症状持续时间小于 1 个月，22%持续 1 至 3 个月，20%持续 4 至 6 个月，15%持续 7 至 12 个月，36%持续时间超过 1 年。72%的患者撕裂仅累及冈上肌；21%的患者累及冈上肌和冈下肌，或伴有小圆肌；7%的患者仅累及肩胛下肌。16%的患者出现肱骨头迁移。48%的患者肌腱回缩轻微，34%的患者位于肱骨头中部，13%的患者位于盂肱关节，5%的患者位于盂下。基线时 VAS 疼痛评分中位数为 4.4。
结果
多变量模型控制其他基线因素后，发现共病（p=0.002）、较低的教育水平（p=0.004）和种族（p=0.041）是与就诊时疼痛相关的唯一显著因素。肩袖撕裂严重程度的任何测量指标均与疼痛无相关性（p＞0.25）。
结论
创伤性肩袖撕裂的解剖特征与疼痛程度无关。与疼痛相关的因素是共病、较低的教育水平和种族。
证据等级
预后 III 级。请参阅作者说明，以获取完整的证据水平描述。
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